Preeclampsia and Eclampsia
Preeclampsia is development of high blood pressure, swelling or high levels of albumin in the urine between the 20th week of pregnancy and the end of the first week after delivery. Eclampsia is development of convulsive seizures or coma without other causes during that same time frame.
Signs of preeclampsia in a pregnant woman include:
- Blood pressure of 140/90
- Systolic blood pressure that rises by 30 mm Hg or more even it if is less than 140. (This is the highest level of blood pressure during the heart's pumping cycle.)
- Diastolic blood pressure that rises by 15 mm Hg or more even if it is less than 90. (This is the lowest level of blood pressure during the heart's pumping cycle.)
- Swelling in the face or hands
- High levels of albumin in the urine
In its milder forms, it may appear as borderline high blood pressure, swelling or water retention that doesn't respond to treatment or albumin in the urine.
Pregnant women who have blood pressure of 150/110, marked swelling or water retention and high levels of albumin in their urine may also experience disturbances in their sight or have pain in the abdomen. Their reflexes may be hypersensitive.
Causes and Risk Factors
It is not known what causes these conditions. Preeclampsia develops in about 5% of pregnant women. These women are usually having their first baby or had high blood pressure or vascular disease before they became pregnant.
If preeclampsia isn't treated it may suddenly turn into eclampsia. Eclampsia can be fatal without treatment. One complication of preeclampsia is a condition where the placenta detaches too early from the wall of the uterus (abruptio placentae).
In addition to the symptoms, a doctor may order blood tests, an analysis of the urine and tests of liver function. He or she will also try to rule out unsuspected kidney disease.
The goal of treatment is to protect the life and health of the mother. This usually assures that the baby survives, too.
When a woman has early, mild preeclampsia, she will need strict bed rest. She should be seen by her doctor every two days. She needs to keep her salt intake at normal levels but drink more water. Staying in bed and lying on her left side will increase her need to urinate. This keeps her from becoming dehydrated and her blood from getting concentrated.
If she doesn't immediately improve, she may need to go into the hospital. Once she has been admitted, she will be given a balanced salt solution intravenously.
She may be given magnesium sulfate intravenously until her reflexes return to normal. This reduces the risk of seizures. At the same time, blood pressure usually goes down. Swelling should begin to go down, too. If the high blood pressure doesn't respond to the magnesium sulfate, other drugs may be tried to lower blood pressure.
Both the mother and baby need constant monitoring. The patient should be observed for complications such as headaches, blurred vision, confusion, abdominal pain, vaginal bleeding or loss of fetal heart sounds. Some doctors may admit the patient directly to the intensive care unit for continuous monitoring of the mother and baby. An obstetrician should be involved in the management of the condition.
At this point the goal of treatment becomes delivery of the baby. Any woman who has preeclampsia that doesn't respond to treatment should be stabilized and delivery accomplished, no matter how long the pregnancy has been. Mild preeclampsia may take six to eight hours to stabilize.
About four to six weeks after the baby is delivered, the signs of preeclampsia should begin to go away.
The patient will need to be watched as closely and as often after delivery as she was during labor. About one out of four cases of eclampsia happen during the first two to four days after delivery.
Although she may need to stay in the hospital longer than a normal delivery would require, a woman usually recovers after delivery quickly. She should be seen by her doctor one to two weeks after the delivery. It may be necessary for her to take drugs to manage high blood pressure.
Cedars-Sinai has a range of comprehensive treatment options.